三维可视化技术与二维影像技术在肝癌患者肝切除术中的疗效比较研究

Comparative study of three-dimensional visualization technology and two-dimensional imaging technology in liver resection of liver cancer patients

目的比较三维可视化技术与二维影像技术在肝癌(LC)患者肝切除术中的疗效。方法采用前瞻性研究方法,选取2014年10月至2018年10月沈阳市第四人民医院收治的118例LC患者,按照随机数字表法将患者分为两组:三维组和二维组,每组各59例。两组患者均行腹腔镜肝切除术,三维组采用三维可视化技术辅助,二维组采用二维影像技术辅助。比较两组患者的手术情况、住院时间、手术前后缺血再灌注肝损伤程度[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBILI)]、血清肿瘤生物学指标[血管内皮生长因子(VEGF)、酸性成纤维细胞生长因子(a FGF)、碱性成纤维细胞生长因子(b FGF)]、并发症发生率,随访1年,比较两组患者的肿瘤复发率和生存率。结果三维组患者的术中失血量[(402.16±84.27) ml]、术中输血量[(1.83±0.21) U]、手术时间[(264.22±43.18)min]、肝门阻断时间[(12.16±3.65) min]、住院时间[(10.33±2.05) d]与二维组[(546.39±90.06) ml、(2.47±0.54)U、(327.10±61.34) min、(15.90±4.11) min、(12.29±3.04) d]比较均明显减少,差异具有统计学意义(P<0.05);术后1 d、3 d、5 d,三维组患者的血清ALT[(349.25±114.05) U/L、(330.51±105.39) U/L、(206.43±55.48) U/L]、AST[(340.77±102.39) U/L、(238.36±40.30) U/L、(72.07±15.25) U/L]、TBILI[(20.91±4.35) mmol/L、(22.36±6.07)mmol/L、(21.33±5.24) mmol/L]、VEGF[(44.20±4.22) ng/ml、(31.59±3.56) ng/ml、(20.24±3.07) ng/ml]、a FGF[(9.11±1.30) pg/L、(7.25±1.06) pg/L、(4.93±1.15) pg/L]、b FGF[(10.50±1.25) pg/L、(7.81±1.14) pg/L、(5.82±1.20) pg/L]水平与二维组[(528.04±176.01) U/L、(452.20±150.70) U/L、(261.32±68.06) U/L,(482.01±157.54)U/L、(279.25±51.29) U/L、(89.14±17.09) U/L,(25.08±5.16) mmol/L、(36.27±10.56) mmol/L、(30.90±7.28)mmol/L,(48.26±5.09) ng/ml、(40.30±4.74) ng/ml、(29.75±4.16) ng/ml,(10.53±1.59) pg/L、(8.39±1.18) pg/L、(7.31±1.63) pg/L,(11.97±1.44) pg/L、(9.22±1.58) pg/L、(7.93±1.71) pg/L]比较均明显降低,差异具有统计学意义(P<0.05);三维组患者的并发症发生率(8.47%)明显低于二维组(22.03%),差异具有统计学意义(P<0.05);三维组患者的1年肿瘤复发率(19.64%)明显低于二维组(36.84%),差异具有统计学意义(P<0.05)。结论与二维影像技术比较,三维可视化技术可为LC切除术提供快速、精准指导,在有效切除病灶基础上最大程度地保留功能肝体积,且可降低并发症发生风险,改善预后。

Objective To compare the efficacy of three-dimensional visualization technology and two-dimensional imaging technology in liver resection of liver cancer(LC)patients.Methods 118 LC patients admitted in Shenyang Fourth People’s Hospital from October 2014 to October 2018 was selected in this prospective study,and they were divided into two groups randomly: the three-dimensional group and the two-dimensional group,59 cases in each group.The patients in both groups underwent laparoscopic liver resection,while the three-dimensional group was assisted by three-dimensional visualization technology,and the two-dimensional group was assisted by two-dimensional imaging technology.The surgical conditions,length of hospital stay,the degree of ischemia-reperfusion liver injury before and after surgery [alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBILI)],serum tumor biological indicators [vascular endothelial growth factor(VEGF),acidic fibroblast growth factor(a FGF),basic fibroblast growth factor(bFGF)],incidence of complications were compared between the two groups.After one year’s follow-up,the recurrence rate and survival rate of the two groups were compared.Results In the three-dimensional group,the blood loss during the operation was(402.16±84.27)ml,the amount of blood transfusion during the operation was(1.83±0.21)U,the operation time was(264.22±43.18)min,the hilar occlusion time was(12.16±3.65)min,and the length of hospital stay was(10.33±2.05)d,which were significantly reduced than the two-dimensional group [(546.39±90.06)ml,(2.47±0.54)U,(327.10±61.34)min,(15.90±4.11)min,(12.29±3.04)d],and the differences were statistically significant(P<0.05).One day,three days,and five days after surgery,the serum ALT levels in the three-dimensional group [(349.25±114.05)U/L,(330.51±105.39)U/L,(206.43±55.48)U/L],AST[(340.77±102.39)U/L,(238.36±40.30)U/L(72.07±15.25)U/L],TBILI[(20.91±4.35)mmol/L,(22.36±6.07)mmol/L,(21.33±5.24)mmol/L],VEGF[(44.20±4.22)ng/ml,(31.59±3.56)ng/ml,(20.24±3.07)ng/ml],a FGF[(9.11±1.30)pg/L,(7.25±1.06)pg/L,(4.93±1.15)pg/L],bFGF[(10.50±1.25)pg/L,(7.81±1.14)pg/L,(5.82±1.20)pg/L]were significantly lower than those in the two-dimensional group [(528.04±176.01)U/L,(452.20±150.70)U/L,(261.32±68.06)U/L;(482.01±157.54)U/L,(279.25±51.29)U/L,(89.14±17.09)U/L;(25.08±5.16)mmol/L,(36.27±10.56)mmol/L,(30.90±7.28)mmol/L;(48.26±5.09)ng/ml,(40.30±4.74)ng/ml,(29.75±4.16)ng/ml;(10.53±1.59)pg/L,(8.39±1.18)pg/L,(7.31±1.63)pg/L;(11.97±1.44)pg/L,(9.22±1.58)pg/L,(7.93±1.71)pg/L],the differences were statistically significant(P <0.05).The incidence of complications in the three-dimensional group(8.47%)was significantly lower than that in the two-dimensional group(22.03%),the difference was statistically significant(P<0.05).The one-year tumor recurrence rate in the three-dimensional group(19.64%)was significantly lower than that in the two-dimensional group(36.84%),the difference was statistically significant(P<0.05).Conclusion Compared with two-dimensional imaging technology,three-dimensional visualization technology can provide fast and accurate guidance for LC resection,preserve functional liver volume to the greatest extent on the basis of effective resection,and reduce the risk of complications and improve prognosis.